1669485868 NPI number — BJC BEHAVIORAL HEALTH

Table of content: (NPI 1669485868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669485868 NPI number — BJC BEHAVIORAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BJC BEHAVIORAL HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669485868
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3309 S KINGSHIGHWAY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63139-1101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-206-3700
Provider Business Mailing Address Fax Number:
314-206-3881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3309 S KINGSHIGHWAY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63139-1101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-206-3700
Provider Business Practice Location Address Fax Number:
314-206-3881
Provider Enumeration Date:
08/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN-DAVIS
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-206-3712

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  267-7258 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 152758215 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7107625 . This is a "MO DEPT OF MENTAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 603805607 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 876175712 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 876175704 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 152758207 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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